On a recent afternoon at Hope Medical Group for Women, an abortion clinic in the far north-west corner of Louisiana, Kathaleen Pittman emptied the coffee pots, turned on the security system, and wondered how many more times she would repeat this end-of-day routine.
“We’re in limbo right now,” said Pittman, the clinic’s administrator, as she flicked off the lights. She shut the door behind her. “Everything now is riding on the court.”
As soon as Monday, the US supreme court is expected to rule in Whole Woman’s Health v Hellerstedt, a case out of Texas in which several abortion providers are challenging one of the harshest abortion restrictions in the nation.
If the law is upheld, nine of Texas’ 19 abortion clinics, which cannot comply with the law’s tough requirements, will be forced to close.
But the decision will also reverberate across Louisiana, where lawmakers have passed a similar restriction requiring all abortion providers to have staff admitting privileges at a hospital not more than 30 miles from their clinic. The law has been blocked in a lower court.
And the supreme court decision is almost certainly going to decide if the law can go into effect – to determine if there will be four abortion clinics to serve the state’s 940,000 women of reproductive age, or just on.
It is the climax of a five-year wave of anti-abortion legislation that has swept the entire country. The eight justices of the court may validate those laws, which have shut down a quarter of the country’s abortion clinics since 2010, or strike an equally powerful blow against them.
And in few places are the stakes so clear as Shreveport, near the Texas border. Hope Medical Group’s fate is riding on this decision: the only doctor there with admitting privileges there has said he would quit if the law went into effect, because he is unwilling to be the only provider in all of northern Louisiana.
The clinic sits in a region that has already been depleted of much of its abortion access, and it is not uncommon for Hope patients to drive 200 miles one way. Seventy-five to 85% live at or below the federal poverty line.
Amy Irvin, who runs a nonprofit, the New Orleans Abortion Fund, that helps low-income women pay for abortions, says the majority of women she hears from are already mothers and struggle to arrange childcare, time off work, transportation, or all of the above.
Only 69% of patients who rely on Hope for abortion services actually live in Louisiana. Many others travel from Texas, Arkansas, and Mississippi – other states where abortion access has been gutted.
“There’s no way, absolutely no way, that one or two physicians could handle the caseload,” said Pittman. “It would be devastating to the region’s access.”
‘Nobody ever expected this.
Louisiana abortion providers have already caught a glimpse of what it would be like if almost every one of the state’s clinics closed. In February, the fifth circuit court of appeals ruled that the admitting privileges law could go into effect while the court heard the abortion providers’ challenge.
Clinics in Baton Rouge and Bossier City cancelled all their appointments. Just two clinics remained in operation, each with only one doctor allowed to perform abortions.
Clinic workers recall chaos.
“It was crazy,” Pittman said. Some 10,000 Louisiana women obtain an abortion every year. The one physician at Hope with admitting privileges began to perform abortions every day, often late into the evening. As wait times for an appointment climbed from a few days to a week to two and a half weeks, she said, patients became more desperate.
“Ladies were crying, begging us to fit them in,” Pittman said. “Because if we couldn’t fit them in, they would have to go even farther away. That takes money. And most of them were terminating for financial reasons.”
In New Orleans, wait times at the Women’s Health Care Center soared. Some women made four-hour round trips from Baton Rouge.
After about a week of this, the supreme court blocked the law until it could resolve the case from Texas. The clinics in Baton Rouge and Bossier City are open once again, for now.
But that one week was enough to spook activists who fear that Women’s Health Care Center can’t handle being the only clinic left open in Louisiana.
It is a particularly small facility. On a recent Friday afternoon, every seat in the waiting room was occupied. Sylvia Cochran, who recently retired as the clinic’s administrator, surveyed the women and their families. “Nobody ever expected this little tiny building to be, quite possibly, the only abortion clinic in the state,” she said.
There’s one other doctor in the state who would be able to operate if admitting privileges became law, at Hope Medical Group. But he says he would quit, a decision that would leave all of Louisiana without an abortion provider.
The doctor, a Shreveport OB-GYN nearing retirement age, said it came down to the fact that he was fearful of being the only doctor performing abortions for hundreds of miles.
“I’d just be a sitting duck,” the doctor told the Guardian, in a rare interview. He spoke about George Tiller and Bernard Slepian, two abortion providers who were murdered by anti-abortion extremists. “I would be very sad to leave this work. But on the flip side, I’m not a martyr.”
The doctor spoke on condition of anonymity, fearing a repeat of the harassment he has experienced in the past.
In the years that he has been involved with Hope, he said, his car tires have been spiked on 12 separate occasions. The clinic has repeatedly been evacuated over credible threats.
But the most intense encounters with anti-abortion activists came just before Louisiana passed admitting privileges into law. A group of abortion protesters from out of town descended on the doctor’s private OB-GYN practice, with one protester trying to force his way in.
At home, his neighbors found their mailboxes stuffed with fliers calling him an “abortionist”, and, he recalled, “asking them to do what they can to harass me, basically.” He asked local police to sweep his house before he entered. The FBI became involved in identifying the protesters.
“It was an experience of real terror for me and my family.” Then Louisiana passed its admitting privileges law, he said, and the safe choice was obvious.
An uneasy moment.
Louisiana’s admitting privileges law dates to 2014. A few years before, Republicans cemented their control over both houses of the legislature for the first time since Reconstruction, and they joined lawmakers across the country who were passing hundreds of new restrictions on abortion.
Their argument in favor of the bill was one of safety. Abortion, people who testified for the law said, carries a serious risk of hospitalization, and emergency rooms often lack the expertise to deal with the complications. There was no real obstacle, they added, to providers obtaining the privileges.
But abortion providers and their allies say that these laws, which are concentrated in the South, are a not-too-subtle attempt to close abortion clinics.
For one, abortion complication rates are exceedingly low. And because they are so low, abortion providers rarely meet a hospitals’ requirements for admitting privileges. Sometimes politics interfere. The six physicians who perform abortions in Louisiana have made at least 11 unsuccessful attempts to obtain admitting privileges from local hospitals.
The supreme court has blocked Louisiana’s admitting privileges law until it weighs in on this same debate in Texas.
If the court splits and the four conservative justices uphold Texas’ law, then admitting privileges would be allowed throughout the fifth circuit court of appeals, which includes Texas and Louisiana.
“It’s an uneasy moment,” said Irvin. “There is a lot of uncertainty as to what the landscape will look like in six months, eight months, a year.”
There is another consideration besides safety, the doctor said. The doctor provides only about one-third of Hope’s abortions. He has admitting privileges at two hospitals within 30 miles of the clinic.
But he obtained them independent of the clinic through his private OB-GYN practice, where he delivers babies and performs inpatient surgeries, such as hysterectomies.
If he were responsible for performing all the abortions in northern Louisiana, then as a practical matter, he would have to give up private practice and admitting privileges.
The doctor wavers on whether he would quit the very same day if the law took effect. Ideally, he said, he would recruit another, younger doctor with admitting privileges to take his place.
The clinic has struggled to recruit such a provider. But the doctor struck an optimistic tone. He himself, he said, became an abortion provider almost by accident.
It was the early 80s, and there weren’t any clinics in northern Louisiana. So women sometimes attempted their own abortions with sharp objects. The doctor remembers horrific complications.
“I did not intend to get involved,” he said. “But nobody else was coming up to the plate, so I just kept doing it.”
(TheGuardian US)
